Monday, October 18, 2010

Changes to the CMS-HCC Model for 2011

As noted in our last post, the updated CMS-HCC Model codes were posted to our website on 9-29-2010.  You can view the file on our Tools Page.  But, what are the changes to the model for 2011?

In short, CMS has:

  • Deleted two codes from the model --279.4 and 453.8.  Both of these codes are truncated codes, i.e., not at the highest level of specificity
  • Deleted three codes from HCC 80--404.03, 404.93 and 404.13.  Note that these codes all still map to HCC 131
  • Added 8 new codes to the model. All of these codes are new ICD-9 codes.  While the codes are effective 10-1-2010, they do not count in the CMS-HCC model until 1-1-2011.
See below for details.

ICD-9-CM CodeICD9_DescriptionCMS-HCC Model CategoryCMS HCC Model 2011 Action TakenComments
40413Ben Hyp Ht/Kid W Hf/Kid80NoDeleted from this HCCAlthough this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.  
2794Autoimmune Disease Nec45NoDeleted from the modelThis diagnosis code was removed from the model. It is not at the highest level of specificity, and more specific codes in this section remain in the model.
4538Venous Thrombosis Nec105NoDeleted from the modelThis diagnosis code was removed from the model. It is not at the highest level of specificity, and more specific codes in this section remain in the model.
40493Hyp Hrt/Kid Nos W Hf/Kid80NoDeleted from this HCCAlthough this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.  
40403Mal Hyp Hrt/Kid W Hf/Kid80NoDeleted from this HCCAlthough this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.  
44770Aortic ectasia, site NOS105YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
56032Fecal impaction31YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
23773Schwannomatosis10YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
23779Neurofibromatosis NEC10YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
78033Post traumatic seizures74YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44773Thoracoabd aortc ectasia105YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44772Abdominal aortic ectasia105YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44771Thoracic aortic ectasia105YesAddedThis is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.


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